The aim of this proposal is to model risks and weaknesses in pre-operative nursing assessments in the freestanding ambulatory surgery center (ASC) setting. Failure to conduct or act upon the findings of the assessment could result in an adverse event including perioperative complications, unanticipated transfer to a higher level of care, and even death. A widely used method to identify risks is "hazard analysis". One form of hazard analysis is the Failure Mode and Effects Analysis (FMEA) which is used to identify and quantify potential failures. Once potential failures are identified, organizations can make changes or put safeguards in place to prevent or lessen the possibility that the failure will occur. The risk analysis component of FMEA will be performed on pre-operative nursing assessments in ten Joint Commission accredited USPI ambulatory surgical centers to identify flaws and weaknesses that will inform prevention strategies. Multidisciplinary staff that play a direct role in, or are knowledgeable about, the pre-operative nursing assessment process from each center will be involved. This will include physicians, nurses and an administrator. A Joint Commission staff member who received specialized training, supported by an engineer from Battelle, will facilitate. The FMEA team and facilitator will examine the assessment process both as it was designed to work and as it is actually implemented. The team will map the assessment processes as they were designed and as they have been implemented, and examine process flow charts for missing steps, redundancies, barriers and other weaknesses. At the completion of the risk analysis, the FMEA team and facilitator will compile and discuss the results, identify process flaws and determine where the process is most vulnerable to breaking down. The remaining portions of the FMEA - root cause analysis of the problem, process redesign, and monitoring - are not a part of this study. However, participating ASCs will be expected to develop a process improvement plan based on the results of their risk analysis and to implement that plan. A copy of the plan will be submitted to the research team. Relevance: Freestanding ASCs are physically detached from inpatient hospitals, thus limiting access to emergency assistance if needed. Accurate pre-operative nursing assessment of a patient's candidacy for a procedure under these conditions is critical to providing safe care and preventing patient harm. Failure to conduct or act upon the findings of a pre-operative assessment could result in an adverse event including perioperative complications, unanticipated transfer to a higher level of care and even death. [unreadable] [unreadable] [unreadable]